Ondansetron

 Risk Factor: BM
 Class: GASTROINTESTINAL AGENTS / Antiemetics

Contents of this page:

Fetal Risk Summary
Breast Feeding Summary
References
Questions and Answers

Fetal Risk Summary

Ondansetron is a potent antiemetic indicated for the prevention and treatment of chemotherapy-induced nausea and vomiting. No adverse effects on fertility or on the fetus were observed in reproduction studies in rats and rabbits at IV doses up to 4 mg/kg/day (1).

Ondansetron has been used in the treatment of hyperemesis gravidarum (2,3,4,5 and 6). A 21-year-old primigravida with severe nausea and vomiting was treated unsuccessfully for approximately 4 weeks, beginning at 6 weeks' gestation, with IV metoclopramide, 10 mg 3 times daily, rectal dimenhydrinate, 100 mg twice daily, and IV fluids (2). Because her condition was considered life-threatening for both herself and her fetus, ondansetron 8 mg IV 3 times daily was instituted at 11 weeks' gestation and continued for 14 days. Significant improvement was noted in the patient's condition from the 2nd day of therapy. The woman eventually gave birth at term to a healthy 3.2-kg girl.

A second report on the use of ondansetron for severe nausea and vomiting in pregnancy involved a 22-year-old woman with renal impairment and nephrotic syndrome (3). Treatment with the antiemetic was begun at 30 weeks' gestation with 8 mg IV 3 times daily for 1 day, then orally (dose not specified) until 33 weeks' gestation. A healthy 2052-g female infant was delivered at 36 weeks by elective cesarean section. The infant remained in good health at an unspecified follow-up period.

A randomized, double-blind study, first published as an abstract (4) and then as a full report (5), compared IV ondansetron (10 mg) (N=15) with IV promethazine (50 mg) (N=15) for the treatment of hyperemesis gravidarum. Both drugs were given as an initial dose followed by as-needed doses every 8 hours. The mean gestational ages of the two groups at the start of therapy were 11.0 and 10.2 weeks, respectively. No differences were observed between the two groups in terms of duration of hospitalization, nausea score, number of doses received, treatment failures, and daily weight gain. The only adverse effect observed was sedation in eight women who received promethazine compared with none in the ondansetron group. No mention was made of the pregnancy outcomes in either group.

Ondansetron, 8 mg IV twice daily, was administered to a woman at 14 weeks' gestation after 6 weeks of unsuccessful therapy with intermittent use of promethazine, prochlorperazine, metoclopramide, and IV hydration (6). IV ondansetron was able to control her vomiting, but not her nausea, and 2 days later she was converted to oral therapy (4 mg) that was taken intermittently (once or twice daily) until 33 weeks' gestation. Nausea occurred throughout her pregnancy, with occasional episodes of vomiting. She eventually delivered a healthy, 2.7-kg male infant at 39 weeks' who was doing well at early follow-up.

Breast Feeding Summary

No reports describing the use of ondansetron during human lactation or measuring the amount, if any, excreted in human milk have been located. The drug has been found in the milk of lactating rats (1). Because of this and its relatively low molecular weight (about 366), excretion into human breast milk should be expected. The effects of exposure to the drug on a nursing infant are unknown.

References

1. Product information. Zofran. Glaxo Wellcome, 1997.
2. Guikontes E, Spantideas A, Diakakis J. Ondansetron and hyperemesis gravidarum. Lancet 1992;340:1223.
3. World MJ. Ondansetron and hyperemesis gravidarum. Lancet 1993;341:185.
4. Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A prospective, randomized, double-blind comparison of the serotonin antagonist ondansetron to a standardized regimen of promethazine for hyperemesis gravidarum. A preliminary investigation (abstract). Am J Obstet Gynecol 1995;172:299.
5. Sullivan CA, Johnson CA, Roach H, Martin RW, Stewart DK, Morrison JC. A pilot study of intravenous ondansetron for hyperemesis gravidarum. Am J Obstet Gynecol 1996;174:15658.
6. Tincello DG, Johnstone MJ. Treatment of hyperemesis gravidarum with the 5-HT3 antagonist ondansetron (Zofran). Postgrad Med J 1996;72:6889.
   
   

Questions and Answers

Anyone know anything about Ondansetron tablets whilst pregnant?

I was constantly sick from 7 weeks pregnant and was always being taken into hospital. I have been taking Ondansetron (Zofran) to stop the sickness. I am afraid that taking it for so long will harm the baby. I am now 18 weeks and I tried to come off it but started throwing up again. Is it safe to take for so long? My GP says she "thinks" so.

wow, i'm impressed with your GP.
Ondansetron is sooooooooo expensive and very effective.
We use it when all other drugs have failed, and we give it intravenously.
Your GP would not give you anything harmful to your baby, however it is advised that you avoid long term use. Therefore you need to come off it.
There are others that you could request, particularly Stemetil, Metoclopromide and valoid. All these are regarded to be safe in pregnancy as there have never been any reports of birth defects associated with their use in pregnancy.

have you tried drug-free remedies? The accupressure bands for your wrists are effective, nibbling ginger biscuits and you can even get ginger chewing gum.

any pregnant women ever taken ondansetron for morning sickness?

my doctor prescribed this to me and it just makes me leary to take it when i read that its for chemo and radiation therapy patients. i know i need to trust the doctor but i guess i just always get so nervous about hurting the baby

This isn't just used for chemo patients, it was originally designed to treat people with chemo because they are collectively a group who suffers from the worst bouts of nausea and vomiting. It works for ANYONE who has extreme nausea and vomiting. It is completely safe to take for morning sickness, if there was any question, they wouldn't prescribe it. They always err on the side of caution when prescribing drugs to pregnant women.

What will help stomach ache in early pregnancy?

I've had a constant stomach ache for 3 weeks now I am 9 weeks pregnant, Ive been in and out of ER for dehydration from all the vomiting and have seen a Gi Dr. I've been on 3 different meds (reglan, ondansetron, phenergan) for the nausea/stomach ache and none work. I've tried gingerale, ginger snaps, ginger pills, flatt coke, crackers, burned toast, small meals, gatoraid, ginger tea, pepermint tea...NOTHING IS WORKING!! Help!!!

I had the same stomach ache even though I was on the anti-naseau pills. As long as your not throwing up the pills ARE working. The pills don't get rid of your stomach ache it helps w/ naseau. I had a stomach ache for nearly 7 weeks straight. There really isn't much relief other than getting on a strict regiment, eating very small snacks very often, sipping not drinking fluids frequently, staying away from heavy foods and try to not get stressed out more than you are. I found that baby food helps a lot becuase I was so sick. My fav is banana, but go out on a limb to try it and try a few different things. I've been in the hospital for being so sick 7 times and 4 times were to stay awhile and get an IV. I've had ultrasounds on my organs and have had blood tests but it's just that some people get really really sick, unfortunately. Stay away from carbonation and stick to fruit and soft foods with occasionaly crackers or toast. I found the canteloupe had B12 in it, it helped (and it tasted good, also contributes to hydration) watermelon would be a good suggestion too. Gatoraid is really sugary so I would go for natural fruit juices (w/o high fructose corn syrup) and cup-a-noodles for food and hydration. You just have to be patient and not expect it to go away w/ a pop of a pill and a gingerale. It took me weeks of strict regimented diets and paying close attention to what worked w/ my body. As long as your not throwing up keep taking Ondaestron (Zofran).

Peppermint tea aids w/ digestion, so once you start being able to eat a lot more drink a cup at night becuase it will help w/ indigestion and it'll help your digestive track out to feel less stressed and swollen. You'll start feeling indigestion and all that in about 6 wks.

im 24 weeks pregnant and have the smallest bump there is.......you cant even tell im pregnant unless i've been

eating heaps that ady which pushes it out more.........i am just getting over hyperemesis (severe vomiting and nausea) whihc has caused me to be very sick and bascialy bed ridden for the past 4 months, in and out of hospital on drips and maxalon/ondansetron shots and i also weigh 10 kgs less now than i did before i got pregnant.........is this normal?? did anyone loose weight while pregnant.....im sure as i get further along i will put on more weight but its borderline 50kgs which i dont think it sufficient enough.....just worried for the health of my bubs

First pregnancies rarely show a baby bump early! When I was 24 weeks with my first, no one knew unless I told them!

My cousin lost weight when she was pregnant in the begining of her pregnancies, too. Everything turned out fine, sometimes it just happens! As long as your Dr says the baby is fine, don't worry.

I am 5 weeks pregnant and can NOT keep anything down...?

I am 5 weeks pregnant and everything I put in my mouth comes right back up..whether it be 30 seconds later or 30 minutes later. This is my first pregnancy and I am 24 years old. I have tried crackers- all different kinds, fruits, rice...everything! I even vomit up the water I drink.
I recently went to the doctor (on friday- its now sunday) and I asked him about my vomitting issue and told him I could not keep anything down. He prescribed me a pill called "ondansetron" that was supposed to help curve my nausea. That didn't work. I feel like nothing is working, and it is a feeling of helplessness. I want my baby to get the nutrition from the foods I eat but how will he/she get them if I can't keep them down long enough to digest? Is there any cause for this? Does ANYONE have any help for me? If you do, please help, Im becoming depressed knowing every meal I have is just going to come right back up no matter how hard I try to hold it down. Thank you in advance for your time & wisdom

Have you tried eating ginger root from the health food store? It was the only thing that worked for my daughter. It's worth a try.

HELP! pregnant and cant stop vomiting, even with medicine.?

i am 3 months pregnant and no matter what i do i'm always feeling like vomiting or i am throwing up. the doctor gave me this Ondansetron Orally Disintegrating Tablets but they hardly help. every time i eat i start gaging, if i'm doing something for long periods of time i start feeling woozy and i end up throwing up. do any one know of anything that would help and not harm my baby? this is driving me nuts, everything i put in comes out at one point, so i'm always hungry. PLEASE HELP!!!

You poor thing! First off, tell your doctor because there are other meds they can give you to help, including a fairly strong one that they give to chemotherapy patients. By this time you have probably experimented all you can with foods to see if there is anything you can tolerate. If you're taking prenatal vitamins, take them with dinner, not in the morning, to tolerate them better. You can also talk to your doctor about different supplements to see if there is one that doesn't set you off.

Eat very small amounts all day. Morning sickness isn't like regular nausea in that having an empty stomach can make it worse. If you can get a few crackers down every hour you might feel some relief. Good luck and talk to your doctor about a stronger medication.

Has Anyone Taken Zofran For Morning Sickness?

My Doctor prescribed me Zofran for morning sickness and I've done research online that states that there are no proven risk's for pregnant women to take this drug. When I had it filled I was given the generic for it called Ondansetron has anyone else taken this or Zofran and were there any side effects? Was it effective with your Morning Sickness?

I took it with my first pregnancy and then with this one. It helped me to take a mixture of medicine. I took the generic of zofran and a phenigrin suppository. If I didn't take the suppository I wasn't able to keep the zofran down. I threw up with my first around 4-12 times a day from 7-12 weeks and with this one I threw up 0-17 times a day from 7-19 weeks. I even passed out a few times with this one because of throwing up so much. I haven't had any side affects from the medicine and my first baby was a healthy happy 8 ib girl apgar 10! Sometimes the medicine works really well and other times it didn't help that much. I was definitly worse off if I didn't take it though. I tried a few times to not take it and that was when I threw up the most. I am currently feeling better and not taking the medicine!!!

morning sickness and the medication my doc gave me.. is it safe?

im 8 weeks pregnant and ive been getting really bad morning sickness but only on certain day not all the time. My doctor gave me ondansetron tablets to take and i was wondering if anyone else out there has ever taken these while pregnant and if anyone knows if these are safe to take. and also... is it normal to have really bad morning sickness one day and then the next day be completely fine?

Yes, this is safe. It's generic for Zofran. I took it through most of my pregnancy. I was in the hospital twice for dehydration. They gave me those tablets and it worked wonders. There's no way I could have gone through my pregnancy without them. I had morning sickness the whole 9 months, those tablets made it more bearable.

What can I do to stop being sick?

So I've been sick for a little more than three weeks, and usually the symptoms include nausea and vomiting. I had a blood test and a stomach x-ray, and my doctor said that everything came out good and that I was healthy, but I can't stop being nauseated.
Since drinking the barium for the x-ray, I've been worst, throwing up constantly and now I can't even stand without getting sick. My doctor prescribed Ondansetron, and that doesn't even work.

And now I'm having stomach pains, etc.

I've even tried drinking glasses of water in case I was dehydrated, and that helped for a while, until I woke up this morning with the same symptoms...

What can I do?

Oh, and by the way, I'm male, so I can't be pregnant.

Um, if you already saw your Doctor why do you think the people on YA can help better them him/her?